Essay on Use of NIV with COPD Patients

Introduction

Chronic obstructive pulmonary disease is a long-lasting continuous airway ailment that is branded by restriction of airflow which is not reversible. It is a core health issue as well as the principal cause of deaths and morbidity (Ozyilmaz, Ugurlu & Nava, 2014). The death rates of this disease are particularly high within middle-aged and elderly individuals in most of developing and developed states. The popularity of COPD is escalating, and by the end of 2022, it may be ranked position three among the most severe ailments (Guarascio et al., 2013). According to a study conducted in America by Chandra et al (2012), it found that almost twenty-four million individuals in the U.S exhibited symptoms of COPD and the disease was the main source of mortality. COPD was liable for over one and a half million emergency attendances, approximately one hundred and twenty thousand deaths, and almost seven hundred thousand hospitalizations. Remarkably, COPD places a lot of financial and economic burden on families, hospital, and in the entire country. This is also the case with exacerbations of COPD. De Torres et al (2014), approximated that 30-10% of total per capita directed to health care expenditure for COPD were solely for exacerbations of COPD. This ailment is linked with acute inflammation episodes due to infection named acute exacerbation of COPD. Furthermore, a crucial number of these individuals abbreviated as AECOPD patients require ventilator support. These patients while compared with other sources of acute respiratory failure appear to reveal greater levels of reintubation, weaning characteristics, and ventilator reliability.

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Various scholars and medical practitioners have demonstrated increased necessity for creation of new techniques for ventilator management particularly for patients suffering from AECOPD. The introduction of non-invasive ventilation abbreviated NIV as the most current approach has transformed the management of patients with AECOPD at various phases (Chandra et al., 2012). A series of well-performed surveys have demonstrated the responsibility of NIV in the ventilatory management of AECOPD patients either at subsequent or initial level. This essay demonstrates comprehension of responsibility of NIV in the treatment of a patient with COPD at various phases.

History of Non-Invasive Ventilation

The first description of utilization of NIV was concentred on patients suffering from respiratory failure subordinate to neuromuscular ailment. Kohnlein et al. (2014) printed a seminal article which described the employment of positive pressure via a nasal mask while these patients were sleeping. NIV was broadly utilized, after the first successful attempt, in individuals with different sources of chronic hypercapnic respiratory failure for instance. Central hypoventilation, neuromuscular ailment, and deformity.

Non-Invasive Ventilation Technical Features

Among the most predominant and essential as aspects of NIV, are ventilator and interface which are crucial in determining its effectiveness.

Ventilator

The type of ventilator employed for NIV takes the form of a small, handy, and easily movable device. Principles and forms of modes present for use together with NIV resemble those employed in conventional ventilators. Furthermore, the novel conventional ventilators may additionally be employed in providing NIV (Mas & Masip, 2014). Therefore, an intensive care unit does not require to buy an NIV ventilator since this modality of ventilation may also be provided to individuals with conventional ventilator which is linked to face mask (Kohnlein et al., 2014). Additionally, other types of a ventilator which include volume-cycled and pressure modes are present. The volume-cycled type of ventilation provides a pre-set air volume equipped with a breath regardless of airway pressure. This makes tolerance of patient using this mode poor since the likelihood of air leaking is often high.

On the other hand, a pressure-cycled form of ventilation is ideal mode used in most NIV. This is because the pre-set pressure is established with expiration and inspiration. This is performed either through bi-level progressive airway compression or continuous progressive airway pressure. When the latter is used, the pre-set pressure is conveyed in the entire cycle of respiratory (Strnad, Prosen & Lesjak, 2016). Consequently, bi-level progressive airway compression utilizes an electronic stirred microprocessor which offers persistent high delivery of low positive pressure that moves between low and high positive pressures. Various surveys have suggested that for intensive care unit which has inadequate NIV experience, bi-level progressive airway compression is the utmost suitable machine to start the treating AECOPD patients (Mas & Masip, 2014).

Interface

This is the bounder between the patient and the machine which is a tight-fitting mask which is composed of silicon. It could be either a full-face or nasal mask that is held in position mainly by using straps (Strnad et al., 2016). The consideration factors for mask relies on the compliance and comfort of the patient and the decision of the practitioner. The size of the mash should be appropriate to fit snugly and ensure that air does not leak. Furthermore, mouth closure is needed for NIV to be efficient when imposed via nasal mask. Where the air leakage is significant, failure of the NIV may happen. Additionally, similar issues may occur in patients with COPD particularity those who must breathe through the mouth. Therefore, is recommended to move to full-face mask in these kinds of patients.

Initial Treatment of AECOPD Patients

The symptoms of AECOPD are often evident and reveal unexpected inequity between the respiratory capacity and load. Additionally, the inciting occurrence of this disease is revealed by the burnup inflammation which occurs in the airways. It, in turn, results in escalated sputum production, bronchospasm, and airway edema. All these outcomes lead to a rise in the resistive and elastic loads as well as deterioration of air load resistance. Furthermore, patients with COPD exacerbation appear to react with quick, narrow, and broadly inefficient breaths which position them at demerits about respiratory mechanics (Vestbo et al., 2013). These patients have escalated dead space breathing which results in additional worsening of the alveolar ventilation. Moreover, such airflow resistance causes a complication known as dynamic hyperinflation that leads to diaphragm flattening which increases the breathing function (Ornico et al., 2013). Remarkably, merging of these two occurrences alters the mechanisms of respiratory to the degree that alveolar ventilation is considerably compromised. The result of this event is a vicious cycle which unless various forms of respiratory support models break it, it may be fatal. Moreover, AECOPD patients clinically appear to be distinctly tachypneic with an exception in the advanced phases, where respiratory encephalopathy and muscle fatigue as a result of abnormalities of blood gas sets in (Strnad et al., 2016). Also, the academia ensues, concurrent hypoxemia and hypercapnic respiratory failure result to worsening of the organ systems of the body such as respiratory muscles.

The most obvious action to treat AECOPD patients using NIV is offloading their respiratory muscles and minimizing their performance load. This results in an improvement in the inequity (Vestbo et al., 2013). Moreover, an upsurge in the tidal volume together with the minimization of the rate of respiratory and subsequent augmentation of the alveolar ventilation may additionally respond to the changed respiratory physiology. NIV makes the inspiratory muscles to offload hence decreasing the breathing performance (Burns et al., 2014). It also results in the development of the minute ventilation or the tidal volume. Besides, this ultimately leads to progression of the alveolar ventilation as well as amelioration present in the hypercapnia and its subsequent severe impacts (Ornico et al., 2013). Also, the expiratory positive airway pressure provided via NIV aids in counteracting inner positive end-expiratory pressure.

Majority of well performed high-quality experiments have precisely recognized the significance of NIV in the acute dealing with patients suffering from AECOPD. NIV had been discovered to decrease the occurrence of the necessity for endotracheal intubation as well as advancing both hospital and ICU endurance. McEvoy et al. (2009), were the first scholars in the twenty-first century to assess the utilization of NIV in AECOPD patients through a study conducted in an open-label non-comparative survey. They concluded that there was progress in physiological abnormalities present in patients with COPD exacerbation. This survey was preceded by a study by Hurst et al. (2010), who made a comparison of results of thirteen patients who had been treated through NIV had similar number thirteen associated historical controls. Additionally, these surveys were trailed by various randomized experiments which compared the plan of initial use of NIV and the normal medical therapy. Majority of these surveys showed a positive outcome which led to a conclusion that the initial NIV utilization resulted in desired developments in abnormalities of blood gas as well as relief in dyspnea (Guarascio et al., 2013). They also found that NIV treatment helped in reducing hospital and ICU stay, reducing death rates of AECOPD patients, and the requirement for endotracheal intubation.

A current investigation on the usage of NIV discovered that it leads to the development of the physiological factors. These were similar outcomes as in the previous studies. There was no controversy over the usage of NIV in the initial dealing with AECOPD patients. Henceforth, NIV should be recommended as standard care for these patients. Nonetheless, information on the utilization of non-invasive ventilation among severely sick individuals has not been categorized. Thus, it must be conceived that previous surveys made a comparison of facilities that used NIV and standard medical therapy rather than endotracheal intubation and NIV. Furthermore, they excluded patients who suffered from severe hypercapnia and advanced academia. An examination conducted by Duggal et al. (2013), made a comparison of the endotracheal intubation and the NIV effectiveness with conventional mechanical ventilation. Every patient in this survey had serious hypercapnia and academia which was discovered to fail medical therapy hence were seen requiring mechanical ventilation. The results of these patients were placed in comparison with their matched past controls managed utilizing conventional techniques in similar hospitals and ICU. A greater degree of NIV failure was recorded while hospital and ICU stay and mechanical ventilation durations did not vary (Guarascio et al., 2013). However, these surveys have been criticized due to relatively lesser mean inspiration pressures utilized in NIV facilities that may be accountable for such a greater degree of failure of NIV. Thus, it is evident that from the previous studies, a considerable part of collected data supports early utilization of NIV merely in a subunit with AECOPD patients.

There are additional factors which may restrict the utilization of NIV. There are termed as contradictions of using NIV. Some of these conditions comprise intestinal obstruction, severe comorbidity, undrained pneumothorax, agitated patient, excessive secretions within the airways, uncooperative patient, and hemodynamic instability. Nevertheless, more currently various data has emerged on the importance of NIV in patients especially those who are affected by the severe type of COPD exacerbations. Demoule et al. (2014), reveale...